skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Long-Term Results Following Postoperative Radiotherapy for Soft Tissue Sarcomas of the Extremity

Abstract

Purpose: To review long-term outcomes following postoperative radiotherapy (RT) for extremity soft tissue sarcoma (STS) and identify variables affecting the therapeutic ratio. Methods and Materials: Between 1970 and 2008, 173 patients with localized extremity STS were treated with postoperative radiation. No patients received prior irradiation. Sixteen percent of tumors had recurred after initial surgery alone; 89% of tumors were high grade. The median patient age was 57 years (range, 18-86 years). Sixty-one percent underwent >1 surgery before RT in an attempt to achieve wide negative margins. Final margin status was negative in 70% and marginal or microscopically positive in 30%. The median time between final surgery and start of RT was 40 days. The median RT dose was 65 Gy (range, 49-74 Gy). The median follow-up for all patients was 10.4 years and 13.2 years among survivors. Results: At 10 years, local control (LC), cause-specific survival (CSS), and overall survival (OS) rates were 87%, 80%, and 70%, respectively, with 89% of local failures occurring within 3 years after treatment. On multivariate analysis, age >55 years (82% vs 93%, P<.05) and recurrent presentation (67% vs 91%, P<.05) were associated with inferior 10-year LC. The LC according to final margin status wasmore » 90% for wide negative margins vs 79% for marginal/microscopically positive margins (P=.08). Age >55 years and local recurrence were associated with inferior CSS and OS on multivariate analysis. Twelve percent of patients experienced grade 3+ toxicity; 12 of these occurred in patients with tumors of the proximal lower extremity, with the most common toxicity of pathologic fracture occurring in 6.3%. Conclusions: This large single-institution series confirms that postoperative RT for STS of the extremities provides good long-term disease control with acceptable toxicity. Our experience supports recurrent presentation and older age as adverse prognostic factors for LC.« less

Authors:
 [1];  [1];  [2]; ;  [1]; ;  [3]; ;  [4];  [1];  [2];  [1]
  1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida (United States)
  2. (United States)
  3. Department of Pathology, University of Florida College of Medicine, Gainesville, Florida (United States)
  4. Department of Orthopedics, University of Florida College of Medicine, Gainesville, Florida (United States)
Publication Date:
OSTI Identifier:
22149644
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; FRACTURES; GY RANGE 10-100; IRRADIATION; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SARCOMAS; SURGERY; TOXICITY

Citation Formats

McGee, Lisa, Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org, University of Florida Proton Therapy Institute, Jacksonville, Florida, Dagan, Roi, Morris, Christopher G., Knapik, Jacquelyn A., Reith, John D., Scarborough, Mark T., Gibbs, C. Parker, Marcus, Robert B., University of Florida Proton Therapy Institute, Jacksonville, Florida, and Zlotecki, Robert A. Long-Term Results Following Postoperative Radiotherapy for Soft Tissue Sarcomas of the Extremity. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.074.
McGee, Lisa, Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org, University of Florida Proton Therapy Institute, Jacksonville, Florida, Dagan, Roi, Morris, Christopher G., Knapik, Jacquelyn A., Reith, John D., Scarborough, Mark T., Gibbs, C. Parker, Marcus, Robert B., University of Florida Proton Therapy Institute, Jacksonville, Florida, & Zlotecki, Robert A. Long-Term Results Following Postoperative Radiotherapy for Soft Tissue Sarcomas of the Extremity. United States. doi:10.1016/J.IJROBP.2012.01.074.
McGee, Lisa, Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org, University of Florida Proton Therapy Institute, Jacksonville, Florida, Dagan, Roi, Morris, Christopher G., Knapik, Jacquelyn A., Reith, John D., Scarborough, Mark T., Gibbs, C. Parker, Marcus, Robert B., University of Florida Proton Therapy Institute, Jacksonville, Florida, and Zlotecki, Robert A. Thu . "Long-Term Results Following Postoperative Radiotherapy for Soft Tissue Sarcomas of the Extremity". United States. doi:10.1016/J.IJROBP.2012.01.074.
@article{osti_22149644,
title = {Long-Term Results Following Postoperative Radiotherapy for Soft Tissue Sarcomas of the Extremity},
author = {McGee, Lisa and Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org and University of Florida Proton Therapy Institute, Jacksonville, Florida and Dagan, Roi and Morris, Christopher G. and Knapik, Jacquelyn A. and Reith, John D. and Scarborough, Mark T. and Gibbs, C. Parker and Marcus, Robert B. and University of Florida Proton Therapy Institute, Jacksonville, Florida and Zlotecki, Robert A.},
abstractNote = {Purpose: To review long-term outcomes following postoperative radiotherapy (RT) for extremity soft tissue sarcoma (STS) and identify variables affecting the therapeutic ratio. Methods and Materials: Between 1970 and 2008, 173 patients with localized extremity STS were treated with postoperative radiation. No patients received prior irradiation. Sixteen percent of tumors had recurred after initial surgery alone; 89% of tumors were high grade. The median patient age was 57 years (range, 18-86 years). Sixty-one percent underwent >1 surgery before RT in an attempt to achieve wide negative margins. Final margin status was negative in 70% and marginal or microscopically positive in 30%. The median time between final surgery and start of RT was 40 days. The median RT dose was 65 Gy (range, 49-74 Gy). The median follow-up for all patients was 10.4 years and 13.2 years among survivors. Results: At 10 years, local control (LC), cause-specific survival (CSS), and overall survival (OS) rates were 87%, 80%, and 70%, respectively, with 89% of local failures occurring within 3 years after treatment. On multivariate analysis, age >55 years (82% vs 93%, P<.05) and recurrent presentation (67% vs 91%, P<.05) were associated with inferior 10-year LC. The LC according to final margin status was 90% for wide negative margins vs 79% for marginal/microscopically positive margins (P=.08). Age >55 years and local recurrence were associated with inferior CSS and OS on multivariate analysis. Twelve percent of patients experienced grade 3+ toxicity; 12 of these occurred in patients with tumors of the proximal lower extremity, with the most common toxicity of pathologic fracture occurring in 6.3%. Conclusions: This large single-institution series confirms that postoperative RT for STS of the extremities provides good long-term disease control with acceptable toxicity. Our experience supports recurrent presentation and older age as adverse prognostic factors for LC.},
doi = {10.1016/J.IJROBP.2012.01.074},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}